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Surgical Anatomy & Approaches MCQs

Practice Set 71 of 102

This practice set contains high-yield board review questions covering key concepts in Surgical Anatomy & Approaches. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1401

Topic: Surgical Anatomy & Approaches

During hip arthroscopy, the placement of the anterolateral portal is performed first. Which of the following nerves is at the greatest risk of iatrogenic injury during the establishment of this specific portal?

. Sciatic nerve
. Pudendal nerve
. Femoral nerve
. Lateral femoral cutaneous nerve
. Obturator nerve

Correct Answer & Explanation

. Lateral femoral cutaneous nerve

Explanation

The lateral femoral cutaneous nerve is highly susceptible to injury during the placement of the anterolateral and mid-anterior portals in hip arthroscopy due to its anatomic proximity to these standard portal sites.

Question 1402

Topic: Surgical Anatomy & Approaches

A 32-year-old water skier sustains a hyperflexion injury of the hip with an extended knee. MRI demonstrates a complete proximal hamstring avulsion with 4 cm of retraction. What is the most appropriate surgical approach for repair?

. Anterior approach to the hip (Smith-Petersen)
. Anterolateral approach to the hip (Watson-Jones)
. Direct lateral approach (Hardinge)
. Posterior subgluteal approach
. Medial approach to the thigh

Correct Answer & Explanation

. Posterior subgluteal approach

Explanation

Proximal hamstring avulsions are approached via a posterior subgluteal approach, often employing a transverse gluteal crease incision. This provides direct access to the ischial tuberosity and allows for identification and protection of the adjacent sciatic nerve during repair.

Question 1403

Topic: Surgical Anatomy & Approaches

During a direct anterior approach for total hip arthroplasty, which nerve is at greatest risk of iatrogenic injury during the superficial dissection between the sartorius and tensor fasciae latae?

. Femoral nerve
. Lateral femoral cutaneous nerve
. Sciatic nerve
. Superior gluteal nerve
. Obturator nerve

Correct Answer & Explanation

. Lateral femoral cutaneous nerve

Explanation

The lateral femoral cutaneous nerve runs superficially near the internervous plane of the direct anterior approach. It is at significant risk of neuropraxia or transection during this exposure.

Question 1404

Topic: Surgical Anatomy & Approaches

During an anterior approach (Smith-Petersen) to the hip for total hip arthroplasty, the surgeon develops the internervous plane between the sartorius and the tensor fasciae latae. Which of the following structures is at greatest risk of injury during the superficial dissection of this approach?

. Ascending branch of the lateral femoral circumflex artery
. Lateral femoral cutaneous nerve
. Femoral nerve
. Superior gluteal nerve
. Profunda femoris artery

Correct Answer & Explanation

. Lateral femoral cutaneous nerve

Explanation

The lateral femoral cutaneous nerve crosses the operative field within the superficial fascia during the anterior (Smith-Petersen) approach. Careful blunt dissection and medial retraction are required to prevent neuropraxia or transection, which can cause anterolateral thigh numbness.

Question 1405

Topic: Surgical Anatomy & Approaches

A 40-year-old man sustains a transverse acetabular fracture with significant posterior wall comminution. Which of the following surgical approaches provides the optimal visualization for direct reduction and fixation of the primary displaced components in this fracture pattern?

. Ilioinguinal approach
. Kocher-Langenbeck approach
. Modified Stoppa approach
. Smith-Petersen approach
. Watson-Jones approach

Correct Answer & Explanation

. Kocher-Langenbeck approach

Explanation

The Kocher-Langenbeck approach is the standard workhorse approach for posterior wall and posterior column fractures. It is also indicated for transverse fractures where the main displacement and comminution involve the posterior wall.

Question 1406

Topic: Surgical Anatomy & Approaches

During hip arthroscopy, excessive traction or prolonged operative time in the supine position most commonly causes neurapraxia to which of the following nerves?

. Lateral femoral cutaneous nerve
. Sciatic nerve
. Pudendal nerve
. Femoral nerve
. Obturator nerve

Correct Answer & Explanation

. Pudendal nerve

Explanation

Pudendal nerve neurapraxia is a well-documented complication of hip arthroscopy due to compression against the perineal post. Minimizing traction time and using a well-padded post or post-less distraction system reduces this risk.

Question 1407

Topic: Surgical Anatomy & Approaches

Which of the following best describes the true internervous plane utilized during the direct anterior approach to the hip?

. Between the tensor fasciae latae (superior gluteal n.) and sartorius (femoral n.)
. Between the gluteus medius (superior gluteal n.) and tensor fasciae latae (superior gluteal n.)
. Between the rectus femoris (femoral n.) and vastus lateralis (femoral n.)
. Between the gluteus maximus (inferior gluteal n.) and gluteus medius (superior gluteal n.)
. Between the sartorius (femoral n.) and rectus femoris (femoral n.)

Correct Answer & Explanation

. Between the tensor fasciae latae (superior gluteal n.) and sartorius (femoral n.)

Explanation

The direct anterior (Smith-Petersen) approach uses a superficial internervous plane between the sartorius (supplied by the femoral nerve) and the tensor fasciae latae (supplied by the superior gluteal nerve). The deep plane is between the rectus femoris and gluteus medius.

Question 1408

Topic: Surgical Anatomy & Approaches

A patient complains of an inability to dorsiflex their foot immediately following a revision THA performed via a posterior approach. The operative report notes that the leg was lengthened by 3.5 cm to achieve stability. Which specific neural structure is most likely injured?

. Tibial division of the sciatic nerve
. Common peroneal division of the sciatic nerve
. Femoral nerve
. Obturator nerve
. Superior gluteal nerve

Correct Answer & Explanation

. Common peroneal division of the sciatic nerve

Explanation

The common peroneal division of the sciatic nerve is tethered at the fibular head and has fewer protective connective tissue elements than the tibial division. It is highly susceptible to stretch injuries, presenting as a foot drop, especially when the limb is lengthened by more than 2 to 3 cm.

Question 1409

Topic: Surgical Anatomy & Approaches

A surgeon is performing a primary total hip arthroplasty using the direct anterior approach. To access the hip joint, the superficial surgical dissection utilizes an internervous plane between which two muscles?

. Tensor fasciae latae and gluteus medius
. Sartorius and tensor fasciae latae
. Rectus femoris and vastus lateralis
. Gluteus maximus and gluteus medius
. Pectineus and adductor longus

Correct Answer & Explanation

. Sartorius and tensor fasciae latae

Explanation

The direct anterior (Smith-Petersen) approach utilizes a true internervous plane between the sartorius (femoral nerve) and the tensor fasciae latae (superior gluteal nerve).

Question 1410

Topic: Surgical Anatomy & Approaches

During surgical approaches to the adult hip, care must be taken to preserve the primary blood supply to the femoral head. This critical blood supply is predominantly derived from which of the following vessels?

. Superficial femoral artery
. Ascending branch of the lateral femoral circumflex artery
. Deep branch of the medial femoral circumflex artery
. Obturator artery via the ligamentum teres
. Inferior gluteal artery

Correct Answer & Explanation

. Deep branch of the medial femoral circumflex artery

Explanation

The major blood supply to the adult femoral head is the deep branch of the medial femoral circumflex artery (MFCA). The contribution from the artery of the ligamentum teres (obturator artery) is negligible in adults.

Question 1411

Topic: Surgical Anatomy & Approaches

The direct anterior approach to the hip utilizes an internervous plane. This plane is located between muscles supplied by which two nerves?

. Inferior gluteal and femoral nerves
. Superior gluteal and obturator nerves
. Femoral and obturator nerves
. Superior gluteal and femoral nerves
. Sciatic and femoral nerves

Correct Answer & Explanation

. Superior gluteal and femoral nerves

Explanation

The direct anterior approach uses the internervous plane between the tensor fasciae latae (supplied by the superior gluteal nerve) and the sartorius (supplied by the femoral nerve).

Question 1412

Topic: Surgical Anatomy & Approaches

During a primary total hip arthroplasty, excessive traction or errant placement of an anterior retractor over the anterior rim of the acetabulum poses the greatest risk to which of the following structures?

. Sciatic nerve
. Superior gluteal nerve
. Femoral nerve
. Obturator nerve
. Pudendal nerve

Correct Answer & Explanation

. Femoral nerve

Explanation

Retractors placed aggressively over the anterior wall of the acetabulum can compress the structures passing under the inguinal ligament. The femoral nerve and vessels are highly susceptible to stretch or compression injury in this location.

Question 1413

Topic: Surgical Anatomy & Approaches

A 65-year-old female undergoes a total hip arthroplasty via the direct anterior (Smith-Petersen) approach. Postoperatively, she demonstrates profound weakness in hip flexion and knee extension, with diminished sensation over the anterior thigh. Which of the following structures was most likely injured during the procedure?

. Femoral nerve
. Sciatic nerve
. Lateral femoral cutaneous nerve
. Superior gluteal nerve
. Obturator nerve

Correct Answer & Explanation

. Femoral nerve

Explanation

The femoral nerve is at risk during the direct anterior approach to the hip, particularly from overly aggressive placement of the medial retractor. Injury results in weakness of the quadriceps (knee extension) and iliopsoas (hip flexion).

Question 1414

Topic: Surgical Anatomy & Approaches

A 68-year-old woman is scheduled for a total hip arthroplasty via a direct anterior approach. Which of the following neurologic structures is at greatest risk of injury during the superficial surgical dissection?

. Sciatic nerve
. Superior gluteal nerve
. Femoral nerve
. Lateral femoral cutaneous nerve
. Obturator nerve

Correct Answer & Explanation

. Lateral femoral cutaneous nerve

Explanation

The direct anterior approach to the hip uses the internervous plane between the tensor fasciae latae (superior gluteal nerve) and the sartorius (femoral nerve). The lateral femoral cutaneous nerve is at highest risk during the superficial dissection.

Question 1415

Topic: Surgical Anatomy & Approaches

A 40-year-old woman undergoes a periacetabular osteotomy (PAO) for symptomatic developmental dysplasia of the hip. During the procedure, the ilioischial osteotomy is performed. Which of the following nerves is at greatest risk of injury during this specific osteotomy cut?

. Femoral nerve
. Obturator nerve
. Sciatic nerve
. Lateral femoral cutaneous nerve
. Superior gluteal nerve

Correct Answer & Explanation

. Sciatic nerve

Explanation

The sciatic nerve lies in close proximity to the posterior column of the acetabulum. It is at highest risk of injury during the ilioischial (posterior) osteotomy phase of a Bernese periacetabular osteotomy if the osteotome penetrates too deeply.

Question 1416

Topic: Surgical Anatomy & Approaches

A 65-year-old woman undergoes a direct anterior approach THA. Postoperatively, she reports a patch of numbness over the anterolateral aspect of her proximal thigh. Motor function is intact. Which nerve was most likely injured during the surgical exposure?

. Femoral nerve
. Obturator nerve
. Lateral femoral cutaneous nerve
. Superior gluteal nerve
. Sciatic nerve

Correct Answer & Explanation

. Lateral femoral cutaneous nerve

Explanation

The lateral femoral cutaneous nerve is at risk during the direct anterior approach (Smith-Petersen interval) to the hip, leading to sensory loss over the anterolateral thigh without motor deficits.

Question 1417

Topic: Surgical Anatomy & Approaches

A 62-year-old woman undergoes a primary THA via a direct anterior approach. Postoperatively, she reports numbness and a burning sensation over the anterolateral aspect of her operative thigh. Which anatomic interval was most likely utilized, leading to this specific nerve injury risk?

. Tensor fasciae latae and sartorius
. Gluteus medius and tensor fasciae latae
. Gluteus maximus and medius
. Rectus femoris and vastus lateralis
. Sartorius and rectus femoris

Correct Answer & Explanation

. Sartorius and rectus femoris

Explanation

The direct anterior (Smith-Petersen) approach exploits the internervous plane between the sartorius (femoral nerve) and tensor fasciae latae (superior gluteal nerve). The lateral femoral cutaneous nerve crosses this interval and is at risk for iatrogenic injury.

Question 1418

Topic: Surgical Anatomy & Approaches

During a direct anterior approach for a total hip arthroplasty, the surgeon develops the internervous plane between the tensor fasciae latae and the sartorius. Which of the following neurologic structures is at greatest risk of injury during the superficial dissection?

. Femoral nerve
. Superior gluteal nerve
. Lateral femoral cutaneous nerve
. Obturator nerve
. Sciatic nerve

Correct Answer & Explanation

. Lateral femoral cutaneous nerve

Explanation

The direct anterior approach utilizes the internervous plane between the sartorius (femoral nerve) and tensor fasciae latae (superior gluteal nerve). The lateral femoral cutaneous nerve courses superficially over the sartorius and is highly vulnerable to traction or transection during the superficial dissection.

Question 1419

Topic: Surgical Anatomy & Approaches

A 45-year-old woman with Crowe Type IV developmental dysplasia of the hip is scheduled for a total hip arthroplasty. Her femoral head is completely dislocated superior to the true acetabulum. If the acetabular component is placed in the true acetabulum, which of the following is most likely required to achieve reduction and prevent nerve injury?

. Greater trochanteric advancement
. Femoral nerve release at the inguinal ligament
. Subtrochanteric femoral shortening osteotomy
. Acetabular structural bone grafting
. Psoas tendon lengthening

Correct Answer & Explanation

. Subtrochanteric femoral shortening osteotomy

Explanation

In Crowe IV dysplasia, the femoral head is dislocated proximally. Bringing the hip down to the true acetabulum significantly lengthens the leg, placing the sciatic nerve at high risk for traction injury, which necessitates a subtrochanteric femoral shortening osteotomy.

Question 1420

Topic: Surgical Anatomy & Approaches

During a direct anterior approach for total hip arthroplasty, the surgeon develops the superficial internervous plane. Which two nerves supply the muscles that form the boundaries of this specific interval?

. Femoral nerve and Superior gluteal nerve
. Femoral nerve and Obturator nerve
. Superior gluteal nerve and Inferior gluteal nerve
. Femoral nerve and Sciatic nerve
. Superior gluteal nerve and Sciatic nerve

Correct Answer & Explanation

. Femoral nerve and Superior gluteal nerve

Explanation

The superficial interval of the direct anterior approach is between the sartorius (femoral nerve) and the tensor fasciae latae (superior gluteal nerve). The deep interval is between the rectus femoris (femoral nerve) and gluteus medius (superior gluteal nerve).

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